P049 Candidemia: Isolate profiling and antifungal susceptibility testing experience from Jodhpur, Western India

Abstract

Objectives: The study was undertaken over a 9-month study period at a tertiary care and super specialty hospital situated in Jodhpur, Western Rajasthan, India, with the following objectives: 1.To determine the prevalence of Candidemia among all blood culture positives 2.Isolate pr ofiling or speciation of Candida spp.3.Antifungal susceptibility testing of the Candida isolates Methods: Automated blood culture bottles (BD BACTEC 960) that flagged positive were taken up for gram staining. Those bottles which showed gram-positive budding yeast with or without pseudohyphae were selected as the study isolates for candidemia. All such bottles were subcultures on Sabouraud's dextrose agar and incubates aerobically at 37 °C for 2-5 days. Creamy, pasty, off-white colonies of Candida were further taken up for identification by germ tube testing, CHROM agar, and VITEK-MS. Antifungal susceptibility testing was performed for all isolates by VITEK 2 against fluconazole, casp ofungin, voriconazole, micafungin, flucytosine, and amphotericin B. Results: During the study period May 1,2021-January 31,2022, the microbiology laboratory received a total of 10 841 automated blood culture bottles, of which, overall, 1051 flagged positive. Budding yeasts were seen in 92 bottles. The prevalence of candidemia was found to be 1.49%. Budding yeasts made up 8.75% of all positive blood cultures. Conventional and automated identification methods showed the non-albicans Candida made up the majority (85.87%) of isolates. Candida tropicalis (43.47%) was the most common species overall, followed by C. parapsilosis (17.37%), C. albicans (14.13%), C. guilliermondi (5.43%), C. glabrata (5.43%), and C. auris (4.34%). Two isolates each of C. kruzei, C. utilis, C. rugosa, and Trichosporon spp. were also obtained. The antifungal susceptibility testing results for the commonest species C. tropicalis showed susceptibility of 90% against casp ofungin and micafungin, 82% against fluconazole and voriconazole, 45% for flucytosine, and 47.5% against amphotericin B.C.albicans showed 100% susceptibility to fluconazole, and casp ofungin, while C.parapsilosis showed a lower susceptibility percentage against all drugs in the panel. The two strains of C. auris were solely susceptible to casp ofungin. Demography of the patients showed a male preponderance (M:F ratio was 2:1). The mean age of patients was 44 years. Conclusion: The prevalence of candidemia in Jodhpur, Western India was found to be 1.45%, a figure much less than that reported from most other tertiary care centers of the country. The commonest isolate was C. tropicalis (43.47%), same as that reported from most Indian studies. Our isolates were largely (> 90%) susceptible to the drug of choice casp ofungin, including the multidrug-resistant C.auris strains.The study findings reflecta low prevalence of candidemia, indicating adequate antibiotic and antifungal stewardship practices at Jodhpur.